Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
St Francis Health Care Foundation Inc
Employer identification number
22-2515066
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
(1)
ST FRANCIS HOSPITAL POUGHKEEPSIE NEW YORK
141338503
03
Yes
Yes
Yes
651,048
Total
651,048
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
St Francis Health Care Foundation Inc
Employer identification number
22-2515066
Identifier
Return Reference
Explanation
Governing Body and Management
FORM 990, PART VI, SECTION A
Line 6: St. Francis Health Care Foundation, Inc. has a single Member, Hastings Health Systems, Inc. Line 7A: Hastings Health System, Inc. as the sole Member of the Foundation, shall elect qualified persons to the Board of Trustees at its Annual meeting in accordance with the provisions of the organization's By-Laws. Line 7b: Hastings Health System, Inc. as the sole Member of the Foundation, shall consider the Annual Report of the Corporation at its Annual Meeting, to be submitted and verified by the President and the Treasurer or a majority of the Trustees. The following powers are reserved exclusively to the Member, and no attempted exercise of any such powers by anyone other than the Member shall be valid or of any force or effect whatsoever: 1. To change the philosophy, mission, and purpose of the corporation; 2. To adopt and/or amend the Certificate of Incorporation; 3. To adopt and/or amend Bylaws, 4. To elect the Board of Trustees and to remove Board members with or without cause; 5. To appoint the President and Chief Executive Officer of the organization; 6. To approve the purchase, sale, lease, mortgage or real property; to approve the purchase, sale, or gift of capital assets; 7. To approve the merger, consolidation, or affiliation of the corporation with another corporation, organization, or program; 8. To approve the dissolution of the corporation and disposition of assets. Line 8: Minutes of each Board meeting shall be taken and disseminated to each Board member as soon as possible after the conclusion of the meeting. Minutes of all meetings of the Board of Trustees, the Executive Committee, or other Board Committees shall reflect all business conducted, including findings, conclusions and recommendations.
Policies
FORM 990, PART VI, SECTION B
Line 1b: The Foundation is reporting 17 of its 19 voting members as being independent. The individuals that are not independent are the President & Ceo of the Hospital, Mr. Robert Savage, the President of the Foundation, Robert Lane, and Board Member Frank Castella. Mr. Castella is not compensated by either the Hospital or the Foundation, however, the Foundation does transact some business with a company owned by Mr. Castella. The amounts paid to Mr. Castella's company did not exceed the $100,000 threshold required for reporting on Schedule L; however, the Foundation felt it was in the interests of full disclosure to report this relationship on the 990 and to indicate that Mr. Castella was, thereby, not independent. Line 11: The Form 990 is presented annually to the Audit and Compliance Committee for review, comment and approval. The presentation includes discussion of the compilation process, current year disclosures, overview of relevant schedules, compliance review, education regarding future changes to the form, and recommendations going forward. Line 12: The Compliance officer of the Organization consistently monitors the annual conflict of interest statements and reports finding to the Audit & Compliance Committee during the quarterly meetings annually or as deemed necessary. Compliance with the policy is mandatory for all employees, officers, directors, trustees and key employees. The Audit and Compliance Committee Receives, reviews and recommends action, if necessary, on all complaints that may be filed by anyone (patient, employee, community, etc.) concerning any charge of "duality of interest" of any such Trustee, Officer, employee, committee member, or department director of the Medical Staff. Line 15: St. Francis Health Care Foundation does not compensate any of its Board Members. All compensation reported on Part VII and Schedule J of the Form 990 is paid by a related organization, St. Francis Hospital, Poughkeepsie. The below processes to determine compensation for those persons reported on Part VII are implemented at the Hospital. The Executive Committee serves as the Compensation Committee for the President and CEO including an annual evaluation of the President and CEO. The Committee utilizes survey data to determine comparability for compensation. Compensation of other Officers and Key Employees is determined by the CEO, with consultation and recommendations from the Executive Committee. Survey data is utilized in conjunction with the standard Hospital annual employee appraisal process.
PUBLIC DISCLOSURE
FORM 990, PART VI, SECTION C
Line 19: The Foundation makes its Form 990 available to the public at its main place of business; likewise, the return is published on the internet at www.guidestar.org. The Foundation's governing documents, conflict of interest policy and financial statements are available to the public upon request and at management's discretion. General information regarding governance, compliance, and financial reporting is made available to the public on the Hospital's website, through annual community benefit reports, and annual publication of the St. Francis Magazine.
FINANCIAL STATEMENTS AND REPORTING
FORM 990, PART XII
Line 2c: The Audit and Compliance Committee has the responsibility for the oversight of the audit of the annual financial statements, and the selection of an independent auditor. Line 3a: The Hospital did not meet the federal award criteria required to undergo an audit as set forth in the Single Audit Act of OMB Circular A-133. Entity wide financial statements audited in accordance with Government Auditing Standards (GAS) have been completed.
Part VII & Schedule O
President of the Foundation, Robert Lane, receives his annual Form W-2 from St. Francis Hospital and his salary is, accordingly, reported on Form 990, Part VII, column (e). Since Mr. Lane spends most of his time engaged in activities related to the Foundation, 70% of his salary is allocated to the Foundation. $177,664 of his 2010 salary has been allocated to the Foundation; $76,142 has been allocated to the Hospital.
Part IX - Functional Expense Reporting
As noted in Schedule O in response to part VI, Line 15, the Foundation does not pay any payroll expenditures directly to employees providing services to the Foundation. All compensation is paid by the Foundation's parent organization, St. Francis Hospital. Accordingly, all salary expenditures reported on Part IX, Line 7 represent the Foundation's allocated portion of salary expenditures [from the Hospital] attributable to employee time spent on Foundation matters. All amounts paid to Robert Lane, President of the Foundation, are likewise included on Line 7, instead of Line 5. On Part IX, Line 21, the amount of $13,609 represented as payments to affiliates was paid to St. Francis Home Health Care. Part XI - Reconciliation of Net assets Unrealized gain: $470,670 Contributions of the purchase of property, plant, & equipment: $132,494 Prior Period Adjustment: $3,243 --------- $606,407 =========
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Mr. Robert Lane TITLE:President HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Mr. Robert Savage TITLE:TRUSTEE HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.